Enhancing biology and providing structural support for acetabular reconstruction in single-stage revision for infection

Abstract

Background Reconstruction of combined segmental and cavitary defects of the acetabulum is a challenge to the hip surgeon. One question regards the efficacy of reconstruction of acetabular defects using a combination of tantalum metal augments (TMAs) and impaction graft in single-stage revision for periprosthetic infection. Materials and methods In the period between July 2009 and August 2014, 24 patients with combined segmental and cavitary acetabular defects and Paprosky classification grade IIB, IIC, and IIIA had hips reconstructed using the combination of TMAs and antibiotic-loaded impaction grafting. A similar group of 30 patients who received single-stage revision without metal augments were identified and taken as control. All patients received a polyethylene cemented cup and long cementless (Wagner SL) stem. Patients were prospectively evaluated using the modified Harris Hip Score (HHS) in addition to radiological evaluation at 3, 6, and 12 months then annually thereafter. Results At an average follow-up period of 4 years (range 2–7 years), all but one patient in the study group were free of infection, indicating a 96% success rate. This rate of eradicating infection was comparable to the 97% success rate in the control group. All metal augments were stable, and good incorporation of the impacted bone graft was observed. The HHS improved significantly from 27 preoperatively to 83 postoperatively ( P < 0.001). Conclusion Metal augments can convert massive acetabular defects to a more contained defect suitable for grafting. The combination of tantalum augments that provide strong structural support and antibiotic-loaded allograft is successful in the mid-term in single-stage revisions for infection. Level of evidence Level IV (prospective case series).

The use of augmented antibiotic-loaded cement spacer in periprosthetic joint infection patients with acetabular bone defect

“…In the study of Ebied et al, hips' reconstruction through the combination of tantalum metal augments (TMAs) and antibiotic-loaded impaction grafting was performed for 24 patients with combined segmental and cavitary acetabular defects. The rate of eradicating infection in that study was 97%, which was similar to our figure [30]. Compared to metal ones, cemented materials may reduce prosthesis-related complications [31].…”

Does Using Highly Porous Tantalum in Revision Total Hip Arthroplasty Reduce the Rate of Periprosthetic Joint Infection? A Systematic Review and Meta-Analysis

“…Finally, 67 articles were selected after full-text evaluation for eligibility. Table 2 provides a summary of the 67 rTHA studies (28,414 hips) showing the studies' characteristics and outcomes [ 12 , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] , [82] , [83] , [84] ]. The stud...…”

“…However, one should be aware of potential limitations of the implants in addressing large defects and discontinuity. Acetabular component and augment 13 Ebied 2019 [ 30 ] Prospective cohort Using a combination of Ta metal augments (TMAs) and impaction graft in single-stage revision for periprosthetic infection 48 5 y (2-7) Metal augments can convert massive acetabular defects to a more contained defect suitable for grafting. The combination of Ta augments that provide strong structural support and antibiotic-loaded allograft is successful in the mid-term in single-stage revisions for infection.…”

Cementless augmented versus cemented Dual Mobility cups: medium-term outcome of case series with a control group

“…However, the usually quoted percentage of minimum 50% contact between the cup and host bone was related to bulk grafts that have a different mode of incorporation and substitution from the fresh frozen chips impacted in 58% of Coptos TH cup cases and revealed full incorporation in 94% of the hips within 24 months. The value of the bone graft was to aid in cup stability, a carrier for the antibiotics, and restore bone stock in case future revision become necessary [23][24][25][26].…”